Vitamin D Deficiency and Sarcopenia in Older Persons

Vitamin D deficiency is a common health problem worldwide, in particular among older people. Vitamin D regulates and modulates the physiology and function of multiple human systems, including the skeletal muscle. The effect of vitamin D on the muscle has been widely investigated, suggesting that this hormone can stimulate the proliferation and differentiation of skeletal muscle fibers, maintaining and improving muscle strength and physical performance. Older persons have a higher prevalence of low Vitamin D levels as a consequence of low dietary intake and reduced ultraviolet irradiation of the skin. Therefore, older people with vitamin D deficiency might be at risk of sarcopenia, a geriatric syndrome characterized by the progressive loss of skeletal muscle mass and strength often complicated by adverse events, such as falls, disability hospitalization and death. Several randomized clinical trials have been conducted to investigate the effect of oral vitamin D supplementation in older patients to prevent or treat sarcopenia, but results are still controversial. In this narrative review we summarize the biological, clinical and epidemiological evidence supporting the hypothesis of a causal association between Vitamin D deficiency and an increased risk of sarcopenia in older people.

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Social Disadvantage Is Associated With Lower Vitamin D Levels in Older People and There Is No Surrogate for Its Measurement

Gerontology and Geriatric Medicine ◽

10.1177/2333721417697843 ◽

2017 ◽

Vol 3 ◽

pp. 233372141769784 ◽

Cited By ~ 1

Author(s):

Adrian H. Heald ◽

Simon G. Anderson ◽

Jonathan J. Scargill ◽

Andrea Short ◽

David Holland ◽

...

Keyword(s):

Vitamin D ◽

Alkaline Phosphatase ◽

Older People ◽

Vitamin D Deficiency ◽

Significant Proportion ◽

Normal Serum ◽

Total Vitamin ◽

Increased Risk ◽

Vitamin D Levels ◽

Lower Vitamin

Introduction: There is increasing evidence concerning adverse health consequences of low vitamin D levels. We determined whether there is any surrogate for measuring vitamin D in people older than 70 years and the relation between index of multiple deprivation (IMD) and vitamin D levels. Methods: Blood samples from 241 patients were included in this analysis. Concurrent measurements for 25-hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH), and bone profile are reported. Results: The prevalence of total vitamin D insufficiency/deficiency (defined as total vitamin D <50 nmol/L) was 57.5% overall. Even for patients with vitamin D deficiency, a significant proportion had PTH, normal calcium, phosphate, and alkaline phosphatase levels. For patients with vitamin D <25 nmol/L, 62.7% had a PTH within reference range, 83.1% had normal serum-adjusted calcium, 80.6% had normal phosphate, and 85.1% had a normal serum alkaline phosphatase. With increasing quintiles of IMD, there was a 22% increased risk of vitamin D deficiency/insufficiency from quintiles 1 to 5, in age- and sex-adjusted logistic regression models (odds ratio [OR] = 1.22, 95% confidence interval [1.01, 1.47]; p = .034). Conclusion: No other parameter is currently adequate for screening for vitamin D deficiency in older people. A higher IMD is associated with lower vitamin D levels in older people.

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Low Vitamin D Levels Predict Mortality in Ankylosing Spondylitis Patients: A Nationwide Population-Based Cohort Study

Nutrients ◽

10.3390/nu12051400 ◽

2020 ◽

Vol 12 (5) ◽

pp. 1400

Author(s):

Niv Ben-Shabat ◽

Abdulla Watad ◽

Aviv Shabat ◽

Nicola Luigi Bragazzi ◽

Doron Comaneshter ◽

...

Keyword(s):

Vitamin D ◽

Cohort Study ◽

Ankylosing Spondylitis ◽

Vitamin D Deficiency ◽

Vitamin D Supplementation ◽

Health Maintenance ◽

Increased Risk ◽

Vitamin D Levels ◽

All Cause Mortality

In this study, we aimed to examine the effect of vitamin D deficiency on all-cause mortality in ankylosing spondylitis (AS) patients and in the general population. This is a retrospective-cohort study based on the electronic database of the largest health-maintenance organization in Israel. AS patients who were first diagnosed between 2002–2007 were included. Controls were matched by age, gender and enrollment-time. Follow-up continued until death or end of study follow-up on 1 July 2019. Laboratory measures of serum 25-hydroxyvitamin-D levels during the entire follow-up period were obtained. A total of 919 AS patients and 4519 controls with a mean time of follow-up of 14.3 years were included. The mean age at the time of enrollment was 52 years, and 22% of them were females. AS was associated with a higher proportion of vitamin D deficiency (odds ratio 1.27 [95% confidence-interval (CI) 1.03–1.58]). In AS patients, insufficient levels of vitamin D (<30 ng/mL) were significantly associated with increased incidence of all-cause mortality (hazard ratio (HR) 1.59 [95% CI 1.02–2.50]). This association was more prominent with the decrease in vitamin D levels (< 20 ng/mL, HR 1.63 [95% CI 1.03–2.60]; <10 ng/mL, HR 1.79 [95% CI 1.01–3.20]) and among male patients (<30 ng/mL, HR 2.11 [95% CI 1.20–3.72]; <20 ng/mL, HR 2.12 [95% CI 1.19–3.80]; <10 ng/mL, HR 2.23 [95% CI 1.12–4.43]). However, inadequate levels of vitamin D among controls were not associated with an increased all-cause mortality. Our study has shown that vitamin D deficiency is more common in AS patients than controls and is linked to an increased risk for all-cause mortality. These results emphasize the need for randomized-controlled trials to evaluate the benefits of vitamin D supplementation as a secondary prevention of mortality in patients with chronic inflammatory rheumatic disease.

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Vitamin D and Vascular Disease

Current Vascular Pharmacology ◽

10.2174/1570161118666200317151955 ◽

2020 ◽

Vol 19 (3) ◽

pp. 250-268 ◽

Cited By ~ 1

Author(s):

Ioanna Gouni-Berthold ◽

Heiner K. Berthold

Keyword(s):

Risk Factors ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Vitamin D Supplementation ◽

Plasma Vitamin ◽

Cvd Risk ◽

Vitamin D Receptors ◽

Cell Proliferation And Differentiation ◽

Increased Risk ◽

Vitamin D Levels

: Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. Vitamin D deficiency has been identified as a potential risk factor for a number of diseases unrelated to the classical skeletal pathophysiology, such as cancer and CVD, but the effects of vitamin D supplementation are less clear. Purpose of this narrative review is to discuss the evidence suggesting an association between vitamin D status and CVD as well as the results of supplementation studies. Vitamin D deficiency has been associated with CVD risk factors such as hypertension, dyslipidemia and diabetes mellitus as well as with cardiovascular events such as myocardial infarction, stroke and heart failure. While vitamin D deficiency might contribute to the development of CVD through its association with risk factors, direct effects of vitamin D on the cardiovascular system may also be involved. Vitamin D receptors are expressed in a variety of tissues, including cardiomyocytes, vascular smooth muscle cells and endothelial cells. Moreover, vitamin D has been shown to affect inflammation, cell proliferation and differentiation. While observational studies support an association between low plasma vitamin D levels and increased risk of CVD, Mendelian randomization studies do not support a causal association between the two. At present, high quality randomized trials do not find evidence of significant effects on CVD endpoints and do not support supplementation of vitamin D to decrease CVD events.

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Vitamin D and schizophrenia: 20 years on

Molecular Psychiatry ◽

10.1038/s41380-021-01025-0 ◽

2021 ◽

Author(s):

Xiaoying Cui ◽

John J. McGrath ◽

Thomas H. J. Burne ◽

Darryl W. Eyles

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Meta Analysis ◽

Vitamin D Supplementation ◽

First Episode ◽

Gamma Aminobutyric Acid ◽

Behavioral Phenotypes ◽

Ongoing Research ◽

Increased Risk ◽

Vitamin D Levels

AbstractMany epidemiological studies have highlighted the link between vitamin D deficiency and schizophrenia. In particular, two prominent studies report an association between neonatal vitamin D deficiency and an increased risk of schizophrenia. In parallel, much has been learnt about the role of vitamin D in the developing central nervous system over the last two decades. Studies in rodent models of developmental vitamin D (DVD)-deficiency describe how brain development is altered leading to a range of neurobiological and behavioral phenotypes of interest to schizophrenia. While glutamate and gamma aminobutyric acid (GABA) systems have been little investigated in these models, alterations in developing dopamine systems are frequently reported. There have been far more studies reporting patients with schizophrenia have an increased risk of vitamin D deficiency compared to well controls. Here we have conducted a systematic review and meta-analysis that basically confirms this association and extends this to first-episode psychosis. However, patients with schizophrenia also have poorer general health, poorer diets, are frequently less active and also have an increased risk of other medical conditions, all factors which reduce circulating vitamin D levels. Therefore, we would urge caution in any causal interpretation of this association. We also summarize the inconsistent results from existing vitamin D supplementation trials in patients with schizophrenia. In respect to animal models of adult vitamin D deficiency, such exposures produce subtle neurochemical alterations and effects on cognition but do not appear to produce behavioral phenotypes of relevance to schizophrenia. We conclude, the hypothesis that vitamin D deficiency during early life may increase the risk of schizophrenia remains plausible and warrants ongoing research.

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Prevalence of vitamin D deficiency and effect of vitamin D supplementation on feto-maternal outcome in tertiary care centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184939 ◽

2018 ◽

Vol 7 (12) ◽

pp. 4912

Author(s):

Munmun Yadav ◽

Mahendra Kumar Verma ◽

Mohan Bairwa ◽

Govardhan Meena ◽

Lata Rajoria

Keyword(s):

Vitamin D ◽

Pregnant Women ◽

Vitamin D Deficiency ◽

Tertiary Care ◽

Serum Vitamin ◽

Vitamin D Supplementation ◽

Serum Vitamin D ◽

Increased Risk ◽

Vitamin D Levels ◽

Risk Of Preeclampsia

Background: Vitamin D deficiency is widely prevalent throughout the world. Pregnant women, neonates and infants form most vulnerable groups for vitamin D deficiency. Hypovitaminosis D in pregnancy has been reported to cause various fetomaternal effect, i.e. increased risk of preeclampsia (PE), gestational diabetes mellitus (GDM), caesarean section, hypocalcemia, subclinical myopathy, neonatal tetany, hyperbilirubinemia congenital rickets and infantile rickets, etc. Only few Indian studies are available in this regard. The objectives are to find prevalence of vitamin D deficiency in pregnant women and to evaluate the effect of supplementation with cholecalciferol in improving vitamin D levels in pregnant women and evaluate its correlation with feto-maternal outcome.Methods: A prospective observational was conducted on 120 Pregnant women on their first visit to hospital irrespective of gestational age were offered the test and on the basis of inclusion and exclusion criteria are included in study and vitamin D level was done to know the prevalence of vitamin D deficiency. Apart from routine obstetrical investigation, serum vitamin D (total) level was estimated. All results were recorded and analyzed statically.Results: Out of 120 patients 101 (84.1%) were found to be vitamin D deficient. Mean age of vitamin D deficient group was 28.31±3.86 and sufficient group was 26.37±2.83.81 (67.5%) were vegetarian and 39 (32.5%) were nonvegetarian.75 (92.59%) vegetarian and 26 (66.66%) non-vegetarian found to be vitamin D deficient. (p<0.05). Vitamin D supplementation has been observed to reduce risk of preeclampsia. (p<0.05) and vitamin D sufficiency associated with reduced risk of low birth weight babies.Conclusions: Vitamin D supplementation reduces risk of maternal comorbidities and helps improve neonatal outcomes.

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667 A Retrospective Review of Vitamin D Levels and Dosing in Burn Center Patients

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.283 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S178-S179

Author(s):

Sara Calder ◽

Asia N Quan ◽

Suzanne Osborn ◽

Virginia Nisbet ◽

Karen J Richey ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Total Body Surface Area ◽

Retrospective Chart Review ◽

Vitamin D Supplementation ◽

High Dose ◽

Burn Patients ◽

Burn Center ◽

Increased Risk ◽

Vitamin D Levels

Abstract Introduction The potential consequences of vitamin D insufficiency/deficiency (I/D) in critically ill patients include: increased ICU length of stay, organ dysfunction, infectious complications, and mortality. Burn patients, in particular, may be at increased risk of vitamin D I/D due to bleeding, systemic inflammatory response syndrome, increased utilization of vitamin D by injured tissues, compromised vascular integrity, fluid shifts, and leakage of vitamin D binding protein (VDBP) and albumin. The purpose of this study is to determine the incidence of vitamin D I/D and evaluate the institutional vitamin D dosing regimen. Methods A retrospective chart review was performed on all adult patients from January 1, 2018 through December 31, 2019 who received cholecalciferol and had at least one 25-hydroxy vitamin D level during their hospitalization. Vitamin D level was drawn on admission, then weekly thereafter. Patients found to be I/D were initiated on high dose vitamin D supplementation and then adjusted based on the weekly levels. The therapeutic goal for vitamin D supplementation was set at 50 ng/ml. Results Three hundred and sixteen patients met criteria for review. Of those patients, 293 patients (93%) were vitamin D I/D. The magnitude of vitamin D deficiency was strongly negatively correlated with increasing % total body surface area (TBSA) burn size (p< 0.001). Mean time to reach therapeutic vitamin D levels following initiation of supplementation was 19 days, requiring an average of 116,125 units cholecalciferol weekly. Time to reach therapeutic levels was also positively correlated with increasing burn size (p< 0.05). Many patients, however, were discharged prior to reaching therapeutic levels. Conclusions Vitamin D I/D is present in over 90% of burn center patients and the degree of I/D was profound. Additionally, vitamin D I/D was not easily corrected, taking almost 3 weeks to reach therapeutic levels using an aggressive supplementation regimen. Further studies documenting the consequences of vitamin D I/D and development of evidence-based supplementation dosing regimens are warranted. Applicability of Research to Practice This study documents common and severe vitamin D deficiency in burn patients, and difficulty in correcting this deficiency.

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Vitamin D Deficiency in Older Patients—Problems of Sarcopenia, Drug Interactions, Management in Deficiency

Nutrients ◽

10.3390/nu13041247 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1247

Author(s):

Małgorzata Kupisz-Urbańska ◽

Paweł Płudowski ◽

Ewa Marcinowska-Suchowierska

Keyword(s):

Vitamin D ◽

Plasma Concentration ◽

Vitamin D Deficiency ◽

Bone Fractures ◽

Hypovitaminosis D ◽

Vitamin D Supplementation ◽

Adverse Outcomes ◽

Vitamin D Metabolism ◽

Increased Risk ◽

Vitamin D Levels

Vitamin D deficiency frequently occurs in older people, especially in individuals with comorbidity and polypharmacotherapy. In this group, low vitamin D plasma concentration is related to osteoporosis, osteomalacia, sarcopenia and myalgia. Vitamin D levels in humans is an effect of the joint interaction of all vitamin D metabolic pathways. Therefore, all factors interfering with individual metabolic stages may affect 25-hydroxyvitamin D plasma concentration. The known factors affecting vitamin D metabolism interfere with cytochrome CYP3A4 activity. There is another group of factors that impairs intestinal vitamin D absorption. The phenomenon of drugs and vitamin D interactions is observed first and foremost in patients with comorbidity. This is a typical situation, where the absence of “hard evidence” is not synonymous with the possible lack of adverse effects. Osteoporosis and sarcopenia (generalized and progressive decrease of skeletal muscle mass and strength) are some of the musculoskeletal consequences of hypovitaminosis D. These consequences are related to an increased risk of adverse outcomes, including bone fractures, physical disabilities, and a lower quality of life. This can lead not only to an increased risk of falls and fractures but is also one of the main causes of frailty syndrome in the aging population. Generally, Vitamin D plasma concentration is significantly lower in subjects with osteoporosis and muscle deterioration. In some observational and uncontrolled treatment studies, vitamin D supplementation resulted in a reduction of proximal myopathy and muscle pain. The most conclusive results were found in subjects with severe vitamin D deficiency and in patients avoiding large doses of vitamin D. However, the role of vitamin D in muscle pathologies is not clear and research has provided conflicting results. This is plausibly due to the heterogeneity of the subjects, vitamin D doses and environmental factors. This report presents data on some problems with vitamin D deficiency in the elderly population and the management of vitamin D deficiency D in successful or unsuccessful aging.

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Implications of Vitamin D Research in Chickens can Advance Human Nutrition and Perspectives for the Future

Current Developments in Nutrition ◽

10.1093/cdn/nzab018 ◽

2021 ◽

Author(s):

Matthew F Warren ◽

Kimberly A Livingston

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Vitamin D Supplementation ◽

The Body ◽

Human Nutrition ◽

Vitamin D Metabolites ◽

Vitamin D Metabolism ◽

Related Research ◽

Vitamin D Intake ◽

Increased Risk

Abstract The risk of vitamin D insufficiency in humans is a global problem that requires improving ways to increase vitamin D intake. Supplements are a primary means for increasing vitamin D intake, but without a clear consensus on what constitutes vitamin D sufficiency, there is toxicity risk with taking supplements. Chickens have been used in many vitamin D-related research studies, especially studies involving vitamin D supplementation. Our state-of-the-art review evaluates vitamin D metabolism and how the different hydroxylated forms are synthesized. We provide an overview with how vitamin D is absorbed, transported, excreted, and what tissues in the body store vitamin D metabolites. We also discuss a number of studies involving vitamin D supplementation with broilers and laying hens. Vitamin D deficiency and toxicity are also described and how they can be caused. The vitamin D receptor (VDR) is important for vitamin D metabolism. However, there is much more that can be understood with VDR in chickens. Potential research aims involving vitamin D and chickens should explore VDR mechanisms which could lead to newer insights with VDR. Utilizing chickens in future research to help with elucidating vitamin D mechanisms has great potential to advance human nutrition. Finding ways to increase vitamin D intake will be necessary because the coronavirus 2019 disease (COVID-19) pandemic is leading to increased risk of vitamin D deficiency in many populations. Chickens can provide a dual purpose with addressing pandemic-caused vitamin D deficiency: 1) vitamin D supplementation gives chickens added value with possibly leading to vitamin D-enriched meat and egg products; and 2) chickens’ use in research provides data for translational research. Expanding vitamin D-related research in chickens to include more nutritional aims in vitamin D status has great implications with developing better strategies to improve human health.

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Supplementation with High Doses of Vitamin D to Subjects without Vitamin D Deficiency May Have Negative Effects: Pooled Data from Four Intervention Trials in Tromsø

ISRN Endocrinology ◽

10.1155/2013/348705 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 17

Author(s):

Rolf Jorde ◽

Moira Strand Hutchinson ◽

Marie Kjærgaard ◽

Monica Sneve ◽

Guri Grimnes

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Serum Lipids ◽

Randomized Clinical Trials ◽

High Sensitivity ◽

Vitamin D Supplementation ◽

High Dose ◽

Negative Effects ◽

The Mean ◽

Hs Crp

Data were pooled from four randomized clinical trials with vitamin D performed in Tromsø with weight reduction, insulin sensitivity, bone density, and depression scores as endpoints. Serum lipids, glycated hemoglobin (HbA1c), and high sensitivity C-Reactive Protein, (HS-CRP) were measured at baseline and after 6–12 months of supplementation with vitamin D 20 000 IU–40 000 IU per week versus placebo. A total of 928 subjects who completed the interventions were included. At baseline the mean serum 25-hydroxyvitamin D (25(OH)D) level in those given vitamin D was 55.9 (20.9) nmol/L and the mean increase was 82.4 (40.1) nmol/L. Compared with the placebo group there was in the vitamin D group at the end of the studies a slight, but significant, increase in HbA1c of 0.04%, an increase in HS-CRP of 0.07 mg/L in those with serum 25(OH)D < 50 nmol/L, and in those with low baseline HDL-C and serum 25(OH)D < 50 nmol/L a slight decrease serum HDL-C of 0.08 mmol/L (P<0.05). No serious side-effects were seen. In conclusion, in subjects without vitamin D deficiency, there is no improvement in serum lipids, HbA1c, or HS-CRP with high dose vitamin D supplementation. If anything, the effect is negative.

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To Supplement or not to Supplement? The Rationale of Vitamin D Supplementation in Systemic Lupus Erythematosus

The Open Rheumatology Journal ◽

10.2174/1874312901812010226 ◽

2018 ◽

Vol 12 (1) ◽

pp. 226-247 ◽

Cited By ~ 1

Author(s):

Alessandra Nerviani ◽

Daniele Mauro ◽

Michele Gilio ◽

Rosa Daniela Grembiale ◽

Myles J. Lewis

Keyword(s):

Systemic Lupus Erythematosus ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Lupus Erythematosus ◽

Clinical Manifestations ◽

Vitamin D Supplementation ◽

Current Evidence ◽

Systemic Lupus ◽

Vitamin D Receptors ◽

Vitamin D Levels

Background: Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease characterised by abnormal activation of the immune system, chronic inflammation and organ damage. Lupus patients are more prone to be vitamin D deficient. However, current evidence is not conclusive with regards to the role played by vitamin D in SLE development, progression, and clinical manifestations. Objective: Here, we will summarise the current knowledge about vitamin D deficiency prevalence, risk factors, molecular effects, and potential pathogenic role in SLE. We will focus on the link between vitamin D deficiency and lupus clinical manifestations, and on the clinical trials assessing the effects of vitamin D supplementation in SLE. Method: A detailed literature search was performed exploiting the available databases, using “vitamin D and lupus/SLE” as keywords. The relevant interventional trials published over the last decade have been considered and the results are reported here. Conclusion: Several immune cells express vitamin D receptors. Thus, an immunomodulatory role for vitamin D in lupus is plausible. Numerous observational studies have investigated the relationship between vitamin D levels and clinical/serological manifestations of SLE with contrasting results. Negative correlations between vitamin D levels and disease activity, fatigue, renal and cardiovascular disease, and anti-dsDNA titres have been described but not conclusively accepted. In experimental models of lupus, vitamin D supplementation can improve the disease. Interventional trials have assessed the potential therapeutic value of vitamin D in SLE, but further larger studies are needed.

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